As the U.S. population ages and becomes increasingly diverse, one of the most pressing issues facing health professionals is providing culturally sensitive end-of-life care. The aim of this project is to develop a multimedia interactive tutorial to integrate cultural issues and end of life care, making both easily accessible to health care professionals. The Patient Self-Determination Act of 1991 guarantees patients the right to participate in decisions about their medical care and to refuse unwanted treatment. Informing patients of these rights and providing them the information necessary to exercise these rights meaningfully requires culturally sensitive communication. Deeply held views about the meaning of death and culturally patterned understandings about the role of the family, therapeutic interventions, and spirituality shape the encounter between patients and clinicians. This tutorial will use a process based model of cross-cultural communication, LEARN, to teach health care providers how to elicit patients' cultural values, beliefs, and preferences, The use of interactive voice recordings will foster skill development in eliciting cultural understandings so that clinicians can act with sensitivity in future encounters whether they begin with knowledge of the patient's culture or know little of it. The emphasis in Phase I will be on informed consent and the role that patients, families, and other key individuals play in decision-making for end-of-life care. The Phase I project will include usability testing and a pilot study of educational effectiveness. In Phase II four additional modules will be developed. These modules will include diverse ways of making sense of death, such as, spirituality and religion; differing views of what happens in the dying process and at the time of death; the role of the family and community in the dying process in various U.S. cultures, and complementary therapeutic interventions. In Phase II a randomized controlled comparison will be used to measure behavioral change in health care providers who complete the tutorial. The Phase I tutorial targets physicians in training. The Phase II tutorial will address the needs of physicians and nurses and will be of interest to a broad spectrum of health care professionals as well. The tutorials will be distributed via established companies that market educational products in our target markets. [unreadable] [unreadable]